In Europe, 8 percent of women smoke throughout their pregnancy. In the Netherlands this is 4 to 5 percent. That equates to about 170,000 people. “That is a difficult group to reach,” says Leonieke Breunis, PhD student at Erasmus MC.
Research
For the study in France, a group of 460 pregnant smoking women was split in two. The first group only received counseling through conversations, the second also received vouchers if they had not smoked. At the end of the study, about 17 percent of the first group had stopped smoking, compared to 32 percent of the second group.
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“That’s a low percentage, but they’re all women who wouldn’t quit without help,” explains Breunis. “With a monetary reward, almost twice as many quit. It does prove that quitting smoking while pregnant is very difficult. There is no treatment that is more effective than this.”
It is even more difficult for pregnant women to stop than for women who are not pregnant, says Breunis. “Then you pee out more nicotine. If you would listen to your body, you would actually smoke more.”
Pat on the back
Mother Eyra Leukfeldt also struggled to quit smoking. During her pregnancy she participated in research at Erasmus MC in which Breunis was involved. “I smoked and was already cutting back, but I couldn’t manage those last five cigarettes,” she tells EditieNL.
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Financial rewards were also used in this study. “The reward was nice. Nobody says no to free coupons.” For her, the coupons had a positive effect. “For me, as a pregnant woman who stops, you get little or no positive feedback, because it should be obvious. Those rewards were a way to give myself a pat on the back.”
Reward
According to Breunis, a reward system helps to combat addictions. “People think: then you don’t stop for the health of your child, but for the money. It’s not like that, they want to do it for the health of their child, but it is very addictive and difficult to stop.”
You do it as a mother-to-be for your child, but there is no guarantee of a healthy baby. “And if you continue, you don’t always get an unhealthy baby. The addictive voice then says, that one cigarette doesn’t matter that much.”
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Rewards do offer a guarantee. “You get that reward anyway if you stop. That makes it tangible and it works in the short term.” In addition, it gives a positive feeling. “Instead of rejecting smoking, you get a reward for not smoking. And it works better with peer pressure from people around you who do smoke.”
Eyra’s daughter is now one year old. “People around me do smoke, but I’ve stopped. A reward doesn’t make you stop and stay stopped, you have to really want it yourself. It’s more of a tool.”
Long-term
Kirsten Ruitenburg, behavioral change specialist, agrees. According to her, the reward system can help in the short term but not in the long term. “If the money disappears, the behavior often disappears. For permanent behavioral change it is important that you have an intrinsic motivation,” she tells EditieNL.
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Impact
Smoking during pregnancy can cause many problems. “The child can be born prematurely, with a low weight and abnormalities such as a cleft lip, asthma and respiratory infections. It can also become overweight later in life. That makes it effective if you let women stop during pregnancy,” says Breunis
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According to her, there is a difference in effectiveness between low and high rewards. “With a high reward you really do it for the money. If the amount is lower, then you are on a slope: am I doing it for the money or for myself? Then they will do it for themselves.”
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Financial incentive
The money incentive is more often used to help people live healthier lives. For example, you can get money from a number of insurance companies if you move a lot. You can get the flu shot at various schools in exchange for a sum of money. And there is extra tax on alcohol and tobacco so that it is slightly more expensive, so that you are less likely to buy it.
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